RINGWORM SYMPTOMS AND TYPES; Made simple with pictures

What is ringworm rash or Tinea? How does ringworm symptoms manifest in a person? How does ringworm pictures look like? These are the questions that bothers many, as ringworm has become more and more common.  

WHAT IS RINGWORM OR TINEA?

 

Ringworm is a type of superficial fungal infection of skin. It is caused by a category of fungus called as dermatophytes. These fungi are kerato-philic. They have a marked predilection for a substance called keratin. That is the reason why dermatophytes grow specifically on keratin-rich structures like nail, hair, outer layer of skin etc. 

RINGWORM SYMPTOMS

Ringworm infection causes a characteristic rash over body. This rash can be annular (ring shaped) or geographic in shape.  

It has an active and advancing border with central inactive clear area. This active border bears scales.

Redness and itching also ensues in ringworm infection. 

RINGWORM TYPES

Ringworm can affect different parts of skin on human body. Based on which there occur a range of ringworm symptoms. Below I have outlined varieties of ringworm or Tinea. 

1. TINEA PEDIS OR ATHLETE’S FOOT

When there is ringworm on foot , then it is called Tinea pedis. This is the most common type of Tinea. It is also named as Athelete’s foot. 

First type of Tinea pedis predominantly involves web space between toes. Especially the site of infection is between 4th and 5th toe. It can expand and spread over upper surface of foot also. The lesion looks dry, cracked, reddish with scaly borders. It is accompanied by severe pruritus or itch. 

In second category of Tinea pedis, it involves lower surface of foot. In that case it develops thick keratin and becomes too dry and cracked. It may appear to be just dry skin, but actually it is an infected foot. 

These people will act like a carrier to disseminate infection to others in community. These people auto-infect themselves also in different areas of body. This second kind of Tinea pedis ( with sole involvement ) is resistant to treatment, and recurrence rate is high. 

2. TINEA CORPORIS

The word “corpus” stands for “body”. When Tinea affects body i.e. trunk, neck, arms and legs then it is called Tinea corporis. Ringworm of face, scalp, hand, feet, buttock and groin etc are not included in definition of Tinea corporis

A child can pick up Tinea corporis through direct contact with infected skin of another person. Also if someone comes in contact with infected pet, soil or infected fomites ( sheets, towel, furniture etc ) then also will develop ringworm of body. 

The type of rash here is typical of ringworm. It usually makes a start as a ring shaped rash which if not treated will progress and cover extensive areas of body in few weeks to months. It will then resemble map of a country.

You can read our another blog, everything you need to know about Ringworm, where we have outlined in detail how a typical ringworm rash looks like and how to differentiate it from other skin infections.

3. TINEA CRURIS OR JOCK ITCH

The word “cruris” is derived from “crural fold”. As one of the usual site of infection is crural fold or groin area i.e. the area between lower abdomen and upper thigh, hence the name “Tinea cruris”

Other common areas for Tinea cruris are upper and inner aspect of both thighs, buttock and buttock folds. Basically, it emerge on areas where chances of sweat accumulation is maximum. Layman’s term for Tinea cruris it is Jock itch

Jock itch is largely a disease of males. Adults and also adolescents i.e. boys between 10-19 years of age may get this infection. Someone who wears tight undergarments and pants and who gets excessive sweat is more likely to get it. Further obese and diabetic kids are more at risk. 

The lesion typically starts at upper inner thigh and then gradually outspreads in a semicircular manner. Whole lesion appears like a reddish patch with scaly border. 

Important note

It is very very rare for Tinea cruris to spread over genitalia or skin of scrotum. Instead it may spread to buttock and buttock folds.

Skin conditions that resemble Tinea cruris or Jock itch:

There are few conditions which are ofttimes confused with “Tinea Cruris”. One is “intertrigo” and another is “Candida” of crura region. These look like Tinea but are not. 

  1. Intertrigo – This is soreness and redness around those areas of body where rubbing and friction happens between two skin surfaces. It is typically observed between upper and inner thigh folds. Hot and humid condition aggregates this. Intertrigo is a skin inflammation ( soreness ) and not an infection. But if it is not taken care of, the area becomes prone to fungal and bacterial infections. 
  2. Candida – Candida is a type of fungus. It can infect crural region as well. This is different from dermatophytes or ringworm. It also infects genital and scrotal area commonly unlike Ringworm or Tinea cruris. In case of doubt KOH wet mount or fungal culture will draw a distinction between the two.

4. TINEA CAPITIS

When dermatophytes infect scalp, it is called Tinea Capitis. The word “capitis” here is derived from “cap”. Here the fungus not only infects scalp, but also inside hair shaft and hair root. This leads to breakage of hair. Sometimes it will also bring about permanent loss of hair ( alopecia ).

5 types of Tinea capitis presentations :

Here shaft of hairs are completely broken off from root. So what you can see is patchy areas with black dots over it. Black dots are actually left out hair roots. 

Here shaft breaks off, yet some part of it is left as a stump along with hair root. This is seen as grey coloured patchy areas over scalp known as Grey patch type of Tinea capitis. 

In this type of scalp ringworm, scalp is covered with itchy and flaky scales. Many times it is confused with seborrheic dermatitis. Seborrheic dermatitis is a different kind of fungal infection known as malassezia. It doesn’t belong to dermatophytes. Here scalp will seem to be covered with too much dandruff. 

 

Diffuse scale type of Tinea capitis is common in young children whereas Seborrheic type in older children. In case of any confusion, KOH mount of scrapping of lesion and fungal culture will help to differentiate. 

This is a type of Tinea which is highly active with a lot of local inflammation and soreness. Here there is a boggy, pus filled patch over scalp which is painful too. If it is not treated on time, it may lead to scarring and permanent loss of hair ( alopecia ) in that area. 

This is a type of Tinea capitis where multiple cup  shaped, yellowish crusts develops over scalp. 

Tinea capitis is common in kids between 4 -14 years of age. When it happens then take proper prescription medication from doctor. This will need oral anti-fungal medication. And will not be relieved by only applying local ointment/lotion/shampoo. 

Tinea Capitis if severe may infect eyebrow and eye lashes as well. At times it will cause fever and lymph nodes Swollen lymph glands can develop over neck areas. 

 

5. TINEA FACIEI

When ringworm involves face, it is called as Tinea faciei. The lesions are similar to that of Tinea corporis / Ringworm of body

It is commonly seen in children and also in young adults.

If it involves small area, it can be treated with local anti fungal agents. 

6. TINEA BARBAE

When Tinea faciei involves beard areas of men then it is called Tinea barbae. 

7. TINEA MANUUM

Ringworm of hand is called Tinea manuum. It can affect 

  • back of hand or 
  • web-space between fingers or 
  • palm of hand 

When it involves first two areas it is like an itchy, scaly and reddish patch. In the third type when it involves palm, then this becomes dry, hard and cracked. 

Two feet one hand syndrome-

When Tinea manuum involves one hand, it is called Tinea Manus. Often it happens that ringworm presents as Tinea pedis ( athlete’s foot ) in both feet and also Tinea Manus in one hand. This common presentation of Ringworm is called “Two feet one hand syndrome”

8. TINEA UNGUIUM

Before going to Tinea unguium, let us get an idea what “onychomycoses” is. “Onycho” means “nail” and “Mycoses” means fungus. Thus Onychomycoses is basically fungal infection of nail. 

Tinea unguium is a subset of Onychomycoses where causative organism is a specific type of fungus called dermatophyte. In lay man’s term Tinea unguium is ringworm of either toe nail or finger nail. Nail becomes discoloured. It is yellowish in colour, brittle and opaque.

Tinea unguium, especially of toe nail takes longer to heal after treatment. It may take 3 months or even more for resolution. 

Conclusion

Ringworm is a very common inefction known since ages. It is described by different names in areas over world. 

Howerever lack of awareness about ringworm or tinea is causing this infection untreated. Hence spread word of awareness. Share this blog so that it can reach to those parents who are simply clueless about it.

Caution

All the informations provided here are for educational and awareness purpose only. Kindly do not use these as alternative to medical consultation.

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